Provider Demographics
NPI:1568784593
Name:BAILEY, TANISA ANTONETTE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:TANISA
Middle Name:ANTONETTE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14013 SE ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-1551
Mailing Address - Country:US
Mailing Address - Phone:206-353-5193
Mailing Address - Fax:
Practice Address - Street 1:12301 NE 10TH PL
Practice Address - Street 2:SUITE 301
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2487
Practice Address - Country:US
Practice Address - Phone:206-353-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011383101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health